Ram Sadhwani* is a banker in his late 40s who spends at least two-three days a week travelling. His long hours at work and travel have had a negative impact on his marital life. A few months ago, while on a short vacation with his wife, Sadhwani found he couldn’t keep an erection firm enough for making love. His wife assured him the situation would resolve itself—after all it had been a while since they had had sex. But when the problem persisted, she suggested they visit a doctor.
The couple’s family doctor suggested he consult an endocrinologist for tests. The endocrinologist asked him to fill out a short questionnaire recommended by the International Index of Erectile Function (IIEF). Sadhwani’s blood was tested for sex hormones, sugar, HDL (high-density lipoprotein), LDL (low-density lipoprotein) and triglyceride levels.
The doctor found his lipid profile to be on the higher side. Higher lipid profiles can lead to heart disease so, as a preventive measure, Sadhwani was prescribed 45-60 minutes of daily exercise and a diet low in fat and rich in fresh fruits and vegetables. He was also prescribed medication to help sustain an erection. In nine months, Sadhwani’s lipid profile was back in a heart-healthy zone and he no longer needed to take the medication.
More common than you think
Erectile dysfunction (ED) is defined as the inability to get and keep an erection firm enough for sex. The symptoms include trouble getting an erection, or sustaining it, and reduced sexual desire. If any or all of these symptoms are present for a sustained period of time, say, more than six months, then it is best to consult the family doctor and, if required, an endocrinologist.
“Are you having trouble making love? This simple question should be routinely asked by doctors particularly during an annual health check-up of a 40-plus man,” says Deepak Jumani, an American Board of Sexology-certified clinical sexologist who has been practising in Mumbai for 30 years. Ritesh Gupta, head of clinical operations, Centre of Excellence for Diabetes, Obesity, Metabolic Disease and Endocrinology, Fortis Healthcare, Vasant Kunj, New Delhi, agrees. This question is important for two reasons: First, if the problem is neglected, it can lead to emotional stress, relationship trouble and depression; and second, ED is one of the earliest markers of heart disease. If a physician knows the answer to this question, perhaps it can help him prescribe the right lifestyle modifications and medicines to stave off heart disease in the future.
It will come as no surprise then that ED affects the quality of your life. A study published in the International Review of Psychiatry in February, done on 90 men by Avasthi A., et al., at the Postgraduate Institute of Medical Education and Research, Chandigarh, showed as much. According to the study, 50% of men suffering from diabetes also suffer from ED. Avasthi and colleagues found that men who were diabetic and suffered from ED had a poorer quality of life than men who had diabetes but did not suffer from ED. The study compared men who were from the same socioeconomic set and of the same age.
But you do not have to live with ED just because you have been diagnosed with diabetes or accept it as a natural part of the ageing process, says Dr Gupta. Help is available and should be sought because ED significantly affects your quality of life and can be the sign of an undiagnosed disease.
“We don’t know exactly how common ED is in Indian men but it is estimated that 50% of men between the age of 40-70 have ED to some degree,” says Dr Gupta. This estimate is based on the Massachusetts Male Aging Study (MMAS), a landmark study embarked upon in the late 1980s to broadly look at the effect of age on various health markers in men. The study sampled 1,079 healthy men between the ages of 40-70 living in New England, US. The study was not designed to look at ED specifically, but that became one of its greatest strengths. The data collected unambiguously showed how common ED actually is and that as men age, more of them suffer from it; in fact, from a more severe case of it. MMAS also showed that men undergoing treatment for heart disease are four times more likely to suffer from ED than men of the same age who are not being treated for heart disease. Similarly, men who suffer from diabetes are three times more likely to suffer from ED than men who are not diabetic. And men with hypertension are 1.5 times more likely to suffer from ED than men who do not have hypertension. MMAS is considered the gold standard of studies on ED in men in the US, to date.
Shashank Joshi, consultant endocrinologist with Lilavati Hospital, Mumbai, says he has seen an increase in the number of cases of ED in thepast 10 years. He attributes this toan increase in diabetes, depressionand heart disease, coupled with increased hormonal fatigue after the age of 40. He also blames the increase in ED cases on the urban, fast-paced, fast-food lifestyle.
There is a way out
“Regardless of how you have ED, whether it is age-related or disease-related, it is not a medical problem that has to be lived with,” says Dr Gupta. “More than 90% of men are successfully treated.”
Many medicines, including beta-blockers, diuretics, antidepressants, anti-allergic medicines and anti-emetics (to prevent vomiting) can cause temporary ED. Dr Gupta says that if your testosterone levels are on the lower side, you should be prescribed hormone replacement. If the medicines you take are causing ED, then your doctor may need to change the medicines. If the blood report shows you have high sugar or lipids, then the doctor will prescribe lifestyle changes, and medication, if required.
Since the brain plays a crucial role in the cascade of physiological events that lead to an erection, it might very well be that your blood report is normal and all you need is a talk with the doctor or a behavioural therapist. Phosphodiesterase type 5 (PDE5) inhibitors such as Sildenafil (Viagra), Tadalafil and Verdanafil are often prescribed and can be taken just prior to sex to help achieve an erection. PDE5 inhibitors work by increasing blood flow to the penis during sexual stimulation. But they do have side effects and can reduce blood pressure so, Dr Gupta says, they should only be taken under medical guidance.
Possible reasons for the dysfunction
• Heart disease
• Clogged blood vessels or atherosclerosis
• Metabolic Syndrome
• Parkinson’s disease
• Multiple sclerosis
• Low hormone function
• Excessive use of tobacco in any form
• Treatments for prostate cancer
• Surgeries that affect the spinal cord or the pelvic area
Note: The symptoms can worsen if you are stressed, fatigued and are having trouble communicating with your partner.
* Name changed to protect privacy.
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